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what is the drug therapy used for anemia?
- treats 2 types of anemia:
- 1. microcytic anemia -- iron deficient
- 2.megaloblastic (macrocytic) anemia
- --vitamin b-12 and folic acid defiency
what two types of iron preparations that support the deficiency of anemias?
- ferrous sulfate (Feosol)--oral form of iron
- iron dextrane (INFed)--IM or IV form of iron
what is the drug therapy for vitamin B-12 deficiency?
vitamin b-12 supplements
what is the drug therapy for folic acid deficiency?
folic acid supplements or vitamin b-12 of supplements+folic acid to hasten the reestablishment of hemopoisesis.
what is the drug therapy used for bleeding disorders (hemofilia)?
- 3 types:
- factor 8 concentrates
- factor 9 concentrates
- desmopressin (DDACP, or stimate)
what is used to treat hemofilia A?
Factor 8 concentrates
what is used to treat hemofilia B?
Factor 9 concentrates
What is the prototype drug to treat hemofilia A?
- plasma derived (hemofil-M)
- --comes from the plasma human derived
- recombinant factor 8 (Advate)
- --comes from hamsters
What is the prototype drug for Hemofilia B?
- plasma derived (Alpha-nine SD)
- --comes from the plasma of human donors
- recombinant factor 9 (BeneFix)
- --comes from hamsters
what is responsible for the transmission of HIV via blood transfusion?
the use of earlier generations for use to treat hemofilia
what is the action of Factor 8 and Factor 9 concentrates?
- two of several clotting factors in the clotting pathway
- co-factors for the clotting factor 10-A.
What are the primary adverse effects for Factor 8 and 9 concentrates?
- allergic reactions:
- --may be mild and patients may only experience rash and itching.
- --may be severe and may experience anaphylaxis such as: difficulty breathing and airway swelling.
what disease is not protected using factor 8 or 9 concrentrates?
creutzfeld-jacob disease which has minimal risk with plasma derived products only
ok with recombinant factor derivatives
what are Interventions would the nurse implement on a patient receiving Factors 8 and Factors 9 concentrates?
- monitor for mild allergic rxns (rash + itch)
- monitor for severe allergic rxns (airway swelling +anaphylactic shock)
What Emergency equipment would you have ready to treat a severe allergic reaction to factor 8 or factor 9?
epinephrine shot for anaphylaxis rxn
What nursing intervention would the nurse implement on a patient experiencing mild allergic rxn to factor 8 or 9?
admin a diphenhydramine or benadryl for itching and rash
what nursing intervention would a nurse explain to a patient with creutz-jacob disease?
prions, the proteins that cause the disease resist inactivation.
How would a nurse administer factor 8 or factor 9 to treat a patient with hemofilia A or B?
- administer factors 8 or 9 IV slowly via bolus for 5-10 mins
- --reconstitute prior to adminstration
- --calculate the dose using the patients bodyweight and the percent of needed factor
Why would the nurse give factor 8 or 9 blood transfusion on demand?
to manage bleeding episodes or prophylactically to prevent bleeding.
admin dose on a regular dose schedule (1-3 dose per week)
What would the nurse explain to the patient regarding the admin of factors 8 or factors 9 to treat hemofilia patient?
assure patients that the risk for viral disease (hepatitis and HIV) is minimal
- recombinant 8 or 9 concentrates are safer than plasma derived concentrates
- --due to risk of prion transmitted infection (creutzfeld-jacob disease)
what would you obtain from patient with a creutzfeld-jacob disease?
baseline of factor 8 or factor 9 level and monitor periodically to ensure the body maintains an adequate level.
What is desmopressin used in treatment?
- antidiuretic hormone (ADH)
- --effective short term on a patient with hemofilia A
- --are experiencing bleeding from a traumatic injury or preparing for surgery.
What is the action of Desmopressin?
it stimulates the release of factor 8 and is used to treat a patient with hemofilia A.
it is only effective with patients whose body is able to produce some form of factor 8
What is the adverse effects of desmopressin?
- fluid retention + hyponatremia
- --result from stimulation of ADH
--hyponatremia develops with hypervolemia due to dilution of solutes in the blood.
What is the drug therapy used to treat and dissolve thrombi or blood clots?
- anticoagulants (aspirin)
- antiplatelets (heparin)
- thrombolytics (
what are the 3 types of anticoagulants that act to prevent the formation of a blood clot (thrombi)?
- 1. interfere with conversion of factor 10 to thrombin
- 2. interfere with conversion of factor 10 to prothrombin
- 3. inhibits the action of vitamin K
what is the use of coagulants in the prevention of blood clots?
used to prevent clots from forming and the extension of existing clots
cant dissolve already formed blood clots
what is the known treatment to dissolve blood clots?
What is anticoagulants used to treat or prevent?
- factor Xa and thrombin inhibitors:
- -treat CVA that are evolving due to a thrombus in a cerebral vessel
- --prevent development of addL pulmonary emboli (DVT) when one or more already developed
- --prevent blood clot during open heart surgery, hemodialysis or blood transfusion